Appropriate concussion management is crucial for ensuring the well-being and long-term health of individuals who have experienced a mild traumatic brain injury. One aspect of concussion management that has received increasing attention is the effect of screen time on acute concussion recovery.
The term ‘screen time’ refers to the amount of time spent using devices with screens such as smartphones, tablets, computers, and television. In today’s digital age, screens are deeply ingrained in daily life and need to be addressed post-concussion to get individuals successfully back to screen exposure for return to school, work, and social activities. This post will explore the effects of screen time on concussion recovery and provide some practical screen time guidelines for individuals recovering from a mild traumatic brain injury.
While electronic screens are a huge part of daily life, they can be particularly taxing on the eyes and brain because they demand constant attention, rapid processing of visual input, and cognitive focus.
Studies on screen time in individuals without a concussion have provided insights into the potential negative effects of screen time on headaches, vision, sleep, and cognition. For example, research has shown that individuals without a concussion who use screens for a prolonged period experience digital eye strain characterized by headaches, blurred vision, and difficulty focusing. In addition, extensive screen time has been linked with sleep disturbances, neck pain, and cognitive fatigue. Lastly, current research has shown an association between headaches and increased screen time. These symptoms are similar to those experienced post-concussion, and there remains a need for more research that investigates the specific impacts of screen time on patients following a traumatic brain injury.
For individuals recovering from a concussion, screen time may negatively impact concussion symptoms in several ways:
Excessive screen time during the concussion recovery process may exacerbate headache symptoms. The cognitive demands of processing rapidly changing information on screens and focusing on the small text and images typical of many electronic devices can lead to visual strain and worsen headaches.
Screen time after a concussion can lead to cognitive overload and fatigue. The fast pace of information presented on screens demands continuous attention and rapid interpretation, which can be overwhelming for a brain healing from injury. Furthermore, the modern multitasking nature of digital devices – such as simultaneously watching, typing, and thinking, can lead to increased mental exhaustion.
Screen time after a concussion can intensify discomfort and strain on the visual system. The brightness and glare from displays can lead to squinting and subsequent eye strain as eyes work harder to focus on high-contrast images and text. In addition, scrolling through content on screens forces the eyes to shift quickly, focus up and down or side to side, increasing eye strain as the eyes work hard to adjust continuously.
Post-concussion, screen time can disrupt sleep patterns, an essential component of the brain’s recovery process. The blue light emitted by screens can suppress melatonin production, the hormone responsible for regulating sleep cycles. As a result, individuals may experience difficulty falling and staying asleep after prolonged exposure to screens at nighttime/before bed.
The stimulating nature of content on screens, whether it’s a gripping TV show or the endless scroll of social media, can also lead to increased mental engagement when the brain should be winding down for rest. This heightened cognitive activity can delay sleep onset and reduce the quality of rest obtained. To mitigate these effects, adopting a screen-free routine 1-2 hours before bedtime can promote healthier sleep habits.
Extended screen time during concussion recovery may impact blurry vision. After a concussion, individuals may have difficulty seeing clearly, which can affect screen-specific tasks such as reading, gaming, or scrolling through social media. When engaging with screens, the eyes must constantly adjust and focus, which can challenge and fatigue the visual system. This strain can intensify the blurriness as the eyes struggle to maintain a sharp image. Additionally, the flicker and glare (i.e., refresh rate) from digital screens can exacerbate visual discomfort and lead to further blurring.
Light sensitivity is a common complaint among concussion patients. Screen time can contribute to discomfort in individuals dealing with post-concussion light sensitivity due to the bright and flickering backlights of digital devices. For those recovering from a concussion, exposure to screen light can exacerbate these symptoms.
Excessive exposure to screens following a head trauma can potentially lead to an increase in concussion symptoms. The high visual demands of screen-based activities may increase the workload on the brain’s visual processing centers, increasing symptoms like blurry vision, eye strain, and headaches. Managing screen time and implementing strategies during concussion recovery can help to minimize symptoms and support the healing process.
It’s intuitive to think that abstinence from screen time would be beneficial for concussion recovery, especially considering the potential for screens to exacerbate symptoms such as headaches, visual dysfunction and sleep disturbances. However, the reality is more nuanced. Despite the logical reasons for limiting screen time, the limited data available on this topic presents a different picture. With only two studies specifically examining post-concussion screen time, the findings suggest a more balanced approach. Let’s examine the research to understand better the optimal approach for patients navigating screen time post-injury.
The first 24-48 hours following a head injury is a critical time for brain recovery and should include cognitive and physical rest. During this phase, it’s imperative that patients minimize their engagement in activities such as work, school, and exercise. Research also highlights the benefits of a brief screen time moderation period during this cognitive rest phase. This includes limiting time spent on computers, smartphones, tablets, and watching television.
A randomized clinical trial examined if screen time in the first 48 hours after a head injury affected concussion symptom recovery time. Patients were either permitted to engage in screen time (screen time permitted group) or asked to abstain from screen time (screen time abstinent group) for 48 hours after head injury. Their results showed that individuals who abstain from screen time or limit screen time to less than 1 hour per day during the first 48 hours had a statistically significant shorter duration of symptom recovery compared to those in the group permitted screen time.
Unfortunately, the study above had some limitations. Firstly, they only looked at symptomatic recovery (the resolution of symptoms) and not clinical recovery such as balance, reaction time, and exercise tolerance, which are necessary for return to play. This is important, as previous research has shown that the resolution of symptoms does not equate to a complete concussion recovery. In addition, the study was based on survey data, which may not be as accurate as looking into exact screen time/app usage in phone settings.
This study offers some of the first clinical evidence supporting the benefits of screen time limitation in the first 48 hours of recovery from concussion; however, further research is needed.
Following the acute rest period after a head injury, patients are advised to listen to their bodies and pace their return to screen time according to symptom resolution. If symptoms such as headache, dizziness, or visual disturbances significantly escalate with screen use, then you should take a break and gradually increase the amount of screen time as symptoms improve.
Research has also found a “sweet spot” in terms of the amount of screen time during the first 30 days after head trauma. Cairncross et al. investigated the association between screen time shortly after injury (7-10 days) and the severity of post-concussion symptoms in children and adolescents for up to 30 days. It was found that individuals in both the low and high amounts of screen time groups were associated with more severe symptoms in comparison to the median screen time group within the first 30 days post-injury. The study suggests that after the first 48 hours, a moderate approach to screen use may be advisable during concussion recovery, implying that neither total abstinence nor excessive use is recommended.
In summary, this study suggests that both screen time extremes can hinder healing during concussion recovery. Too little screen time can inadvertently lead to social isolation and other negative effects. In today’s connected society, screens serve as a primary means for communication, staying in touch with family and friends, engaging in school or work activities, and accessing entertainment. Complete screen time abstinence can result in feelings of loneliness and disconnection during a time when social support is vital.
Conversely, too much screen time can lead to an overload of symptoms. The visual and cognitive demands of prolonged screen use can intensify headaches, eyestrain, and mental fatigue. For those recovering from a concussion, it’s crucial to find a balance that allows for the benefits of staying connected without overly aggravating concussion symptoms.
It’s crucial to note that every concussion is unique, and recovery times can vary significantly from person to person. Therefore, working with a healthcare professional who can provide personalized recommendations for managing screen time during concussion recovery is essential.
After a concussion, reintroducing screen time is essential for return to school, work and social activities. While complete screen time abstinence may not be helpful, limiting excessive screen time may be beneficial for individuals recovering from traumatic brain injuries.
Here are practical tips to facilitate a gradual return to electronic screens:
It’s important to remember these tips should be personalized based on individual progress and self-reported symptoms. Working with a healthcare professional to develop an individualized recovery plan is crucial for optimizing screen time management and promoting concussion recovery.
While some concussion symptoms can be exacerbated by screen time, blue light glasses have been discussed as a possible way to mitigate these negative effects. Blue light glasses are specifically designed to filter out blue light emitted by screens. This type of light is known for its high energy and short wavelengths, which may contribute to digital eye strain. In addition, excessive exposure to artificial blue light from screens, especially during the evening, can suppress the production of melatonin, which can interfere with a person’s ability to fall asleep and maintain restful sleep.
While blue light glasses may offer benefits in reducing eye strain during screen use, not all exposure to blue light is detrimental to our health. Certain amounts of blue light are beneficial, particularly during daytime hours. Blue light exposure from natural sources like sunlight is crucial for maintaining our natural circadian rhythm—the body’s internal clock that regulates sleep and wakefulness. It boosts alertness, helps memory and cognitive function, and elevates mood.
Recent studies suggest that blue light exposure in the morning may also have potential benefits post concussion. More specifically, the research by Raikes et al., and Killgore et al., highlights the therapeutic potential of blue light therapy in the context of concussion recovery and its effects on sleep disruption. According to the study, engaging in daily morning exposure to blue light therapy can significantly improve the structure and function of the brain, which are often compromised after an injury. The therapy works by regulating the circadian rhythm, which in turn, enhances sleep quality and duration. Furthermore, the impact of blue light therapy extends beyond sleep improvement, as research also indicates potential benefits in cognitive function and mood.
Therefore, while managing screen time and blue light exposure is necessary, blue light glasses during screen use should be limited to the evening and nighttime. Further research is needed to determine the exact role that blue light glasses and blue light therapy may play in concussion recovery.
In conclusion, navigating screen time during concussion recovery is a delicate balance that should be personalized to each individual’s circumstances. Ultimately, concussion management is about finding the right balance between rest, gradual re-exposure to electronic screens, and returning to pre-injury screen use for school, work, and social activities.
Cairncross, M., Yeates, K. O., Tang, K., Madigan, S., Beauchamp, M. H., Craig, W., Doan, Q., Zemek, R., Kowalski, K., & Silverberg, N. D. (2022). Early Postinjury Screen Time and Concussion Recovery. Pediatrics, 150(5). On behalf of the Pediatric Emergency Research Canada A-CAP study team
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